Compact endoscopic surgical blade assembly and method of use thereof

ABSTRACT

An endoscopic surgical device comprising a slotted clear cannula, a blade and a housing, wherein the cannula is attached to the housing, and wherein the blade is enclosed in the housing and is slidable into the cannula is disclosed. The blade is enclosed within the housing and cannula, and has a horizontally-oriented pushing component and a vertically-oriented cutting component that protrudes through the slot of the cannula. A method for a performing an operative procedure on a target tissue in a subject using the endoscopic surgical device is also described.

This application is a continuation application of U.S. patentapplication Ser. No. 13/790,016, filed on Mar. 8, 2013, which is acontinuation-in-part application of U.S. patent application Ser. No.13/602,968, filed on Sep. 4, 2012. The entirety of the aforementionedapplications is incorporated herein by reference.

FIELD

This application generally relates to medical devices. In particular,the application relates to devices and methods for endoscopic surgery,e.g., for endoscopic tunnel or pulley release surgery.

BACKGROUND

Endoscopic surgery is a minimally invasive surgical procedure that isperformed through small incisions or natural body openings. Anendoscopic procedure typically involves use of specialized devices andremote-control manipulation of instruments with indirect observation ofthe surgical field through an endoscope or similar device. Comparing toopen surgery, endoscopic surgery may result in shorter hospital stays,or allow outpatient treatment.

Trigger finger is characterized by catching, snapping or locking of theinvolved finger flexor tendon, associated with dysfunction and pain.Localized inflammation or nodular swelling of said flexor tendon causesa disparity in size between the flexor tendon and the surroundingretinacular pulley system, most commonly at the level of the firstannular (A1) pulley. When the subject extends the involved finger, thetendon will “catch” on the pulley, followed by an abrupt popping of thetendon through the pulley. This results in a difficulty flexing orextending the finger and the “triggering” phenomenon. Typically, a firstcourse of treatment for trigger finger is corticosteroid injections intothe tendon sheath to reduce inflammation. When corticosteroid injectionis not or no longer effective, surgical division of the A1 pulley isindicated.

Carpal tunnel syndrome is an entrapment median neuropathy resulting fromcompression of the median nerve at the wrist in the carpal tunnel.Symptoms of carpal tunnel syndrome include tingling, numbness, weakness,or pain felt in the fingers supplied by the median nerve or in the palm.Repetitive tasks, force, posture, and vibration have been cited ascausative or contributing factors to carpal tunnel syndrome. Palliativetreatments for carpal tunnel syndrome include direct corticosteroidinjections, splinting, oral corticosteroids and/or behaviormodification. Failure of these methods within a reasonable period oftime, and/or the presence of other contributing factors, indicates aneed for surgical division of the carpal tunnel.

Other conditions involving the compression of a nerve by a ligamentpulley or tunnel include Guyon's tunnel (or canal) syndrome, which is acompression of the ulnar nerve as it passes through Guyon's tunnel atthe wrist; cubital tunnel syndrome, which is a compression of the ulnarnerve as it passes through the cubital tunnel at the elbow; radialtunnel syndrome, which is a compression of the radial nerve as ittravels from the brachial plexus to the wrist and hand; and pronaterteres syndrome, which is a compression neuropathy of the median nerve inthe region of the elbow.

Conventional surgical techniques and equipment for pulley or tunnelrelease require a fairly large incision over the pulley or tunnel andspreading of the incision to allow viewing and instrument access. Thesetechniques can require a longer period of recovery than endoscopicmethods and have greater levels of post-operative pain due to theincision size and level of manipulation during the procedure.

Typically, endoscopic surgery has involved a number of steps andseparate devices for performing pulley or tunnel division. After makingan incision and opening a path to the pulley or tunnel using a bluntinstrument, a cannula is inserted into the path. Briefly, in order tosmoothly insert the cannula, the central lumen of the cannula must befilled with a device, such as an obturator. The obturator is thenremoved and an endoscope, or arthroscope, is inserted into the cannulato view the pulley or tunnel. The endoscope is then withdrawn from thecannula, a knife is either advanced into the cannula for division or aspecialized knife assembly is affixed to the endoscope and theknife/endoscope assembly is advanced into the cannula for division. Thepresent application fulfills a need in the art for a compact device foruniportal endoscopic pulley or tunnel release surgery that eliminatesthe need for a separate device, such as an obturator, for filling thecannula during insertion and eliminates the need to remove the endoscopein order to insert a blade or blade assembly.

SUMMARY

One aspect of the present application relates to an endoscopic surgicaldevice, comprising: (a) a housing having a proximate end and a distalend; (b) a slotted clear cannula attached to said distal end of saidhousing, said slotted clear cannula comprises a cannula body having aproximate end and a distal end, and a slot extending from said proximateend of said cannula to the proximity of said distal end of said cannula;(c) a revolver assembly located within said housing, comprising: a slidelock having a proximate end, a distal end and two notches at said distalend; a scraper; a blade assembly; and a circular revolver bodycomprising a selector switch; wherein said scraper and said blade resideat said two notches of said slide lock in a pre-deployment position andwherein said selector switch allows selection of said scraper or saidblade for deployment; and (d) a tube assembly having a proximate end anda distal end, said distal end of said tube assembly is located withinsaid housing and extends through said revolver, said tube assembly iscapable of entering said slotted clear cannula from said proximate endof said clear cannula.

Another aspect of the present invention relates to an endoscopicsurgical kit, comprising an endoscope and an endoscopic surgical device,comprising: (a) a housing having a proximate end and a distal end; (b) aslotted clear cannula attached to said distal end of said housing, saidslotted clear cannula comprises a cannula body having a proximate endand a distal end, and a slot extending from said proximate end of saidcannula to the proximity of said distal end of said cannula; (c) arevolver assembly located within said housing, comprising: a slide lockhaving a proximate end, a distal end and two notches at said distal end;a scraper; a blade assembly; and a circular revolver body comprising aselector switch; wherein said scraper and said blade reside at said twonotches of said slide lock in a pre-deployment position and wherein saidselector switch allows selection of said scraper or said blade fordeployment; and (d) a tube assembly having a proximate end and a distalend, said distal end of said tube assembly is located within saidhousing and extends through said revolver, said tube assembly is capableof entering said slotted clear cannula from said proximate end of saidclear cannula.

Another aspect of the present invention relates to a method for aperforming a uniportal endoscopic surgical procedure on a target tissueusing an endoscopic surgical device, comprising: (a) a housing having aproximate end and a distal end; (b) a slotted clear cannula attached tosaid distal end of said housing, said slotted clear cannula comprises acannula body having a proximate end and a distal end, and a slotextending from said proximate end of said cannula to the proximity ofsaid distal end of said cannula; (c) a revolver assembly located withinsaid housing, comprising: a slide lock having a proximate end, a distalend and two notches at said distal end; a scraper; a blade assembly; anda circular revolver body comprising a selector switch; wherein saidscraper and said blade reside at said two notches of said slide lock ina pre-deployment position and wherein said selector switch allowsselection of said scraper or said blade for deployment; and (d) a tubeassembly having a proximate end and a distal end, said distal end ofsaid tube assembly is located within said housing and extends throughsaid revolver, said tube assembly is capable of entering said slottedclear cannula from said proximate end of said clear cannula, comprising:establishing an entry portal in said subject, inserting into said entryportal said cannula of said endoscopic surgical device; extending saidcannula through said entry portal to said target tissue; advancing anendoscope into said cannula visualize a target tissue; and advancingsaid blade into said cannula until a desired cut is made on said targettissue.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention can be better understood by reference to thefollowing drawings. The drawings are merely exemplary to illustratecertain features that may be used singularly or in combination withother features and the present invention should not be limited to theembodiments shown.

FIG. 1 is an exploded view of one embodiment of the device of thepresent application.

FIG. 2 is a perspective view of another embodiment of the device of thepresent application.

FIG. 3 is a perspective view of another embodiment of the device of thepresent application.

FIG. 4 is an exploded view of the embodiment of the embodiment depictedin FIG. 3.

FIG. 5 shows individual components of the embodiment depicted in FIG. 3.

FIG. 6 is a cutaway view of the embodiment of the embodiment depicted inFIG. 3.

FIG. 7 is an exploded view of individual components of the embodimentdepicted in FIG. 3.

FIGS. 8A-F show the orientation of the internal components in side view(A, C, E) and end view (B, D, F) of the embodiment of FIG. 3 for theadvancement of an endoscope alone (A, B), an endoscope with a scraper(C, D) or an endoscope with a blade (E, F).

FIG. 9 is a perspective view of another embodiment of the device of thepresent application.

FIG. 10 is an exploded view of the embodiment depicted in FIG. 9.

FIGS. 11A-E show perspective and cross-sectional views of the cannulaelement of the embodiment depicted in FIG. 9.

FIGS. 12A-F show perspective and cross-sectional views of the top shellof the housing of the embodiment depicted in FIG. 9.

FIGS. 13A-F show perspective and cross-sectional views of the bottomshell of the housing of the embodiment depicted in FIG. 9.

FIGS. 14A-E show perspective and cross-sectional views of the revolverelement of the embodiment depicted in FIG. 9.

FIGS. 15A-E show perspective and cross-sectional views of the slide lockelement of the embodiment depicted in FIG. 9.

FIGS. 16A-E show perspective and cross-sectional views of the rotaryclip element of the embodiment depicted in FIG. 9.

FIGS. 17A-D show perspective views of the tube assembly element of theembodiment depicted in FIG. 9.

FIGS. 18A-C show perspective views of the blade tool element of theembodiment depicted in FIG. 9.

FIGS. 19A-E show perspective and cross-sectional views of the blade ofFIGS. 18A-C.

FIG. 20 shows a perspective view of the blade element of the embodimentdepicted in FIG. 9, as deployed through the slot in the cannula.

FIG. 21 shows another perspective view of the blade element of theembodiment depicted in FIG. 9, as deployed through the slot in thecannula.

FIG. 22 shows a side perspective view of the embodiment depicted in FIG.9 with the blade deployed through the slot in the cannula.

FIGS. 23A-E show perspective views of the scraper element of theembodiment depicted in FIG. 9.

FIG. 24 shows a perspective view of the scraper element of theembodiment depicted in FIG. 9, as deployed through the slot in thecannula.

FIG. 25 shows a side perspective view of the embodiment depicted in FIG.9 with the scraper deployed through the slot in the cannula.

FIG. 26 shows a top perspective view of the embodiment depicted in FIG.9 with the scraper deployed through the slot in the cannula.

DETAILED DESCRIPTION

The following detailed description is presented to enable any personskilled in the art to make and use the invention. For purposes ofexplanation, specific nomenclature is set forth to provide a thoroughunderstanding of the present invention. However, it will be apparent toone skilled in the art that these specific details are not required topractice the invention. Descriptions of specific applications areprovided only as representative examples. The present invention is notintended to be limited to the embodiments shown, but is to be accordedthe widest possible scope consistent with the principles and featuresdisclosed herein.

This description is intended to be read in connection with theaccompanying drawings, which are to be considered part of the entirewritten description of this application. The drawing figures are notnecessarily to scale and certain features of the application may beshown exaggerated in scale or in somewhat schematic form in the interestof clarity and conciseness. In the description, relative terms such as“front,” “back,” “up,” “down,” “top,” “bottom,” “upper,” “lower,”“distal,” and “proximate” as well as derivatives thereof, should beconstrued to refer to the orientation as then described or as shown inthe drawing figure under discussion. These relative terms are forconvenience of description and normally are not intended to require aparticular orientation. Terms concerning attachments, coupling and thelike, such as “connected,” “mounted,” and “attached,” refer to arelationship wherein structures are secured or attached to one anothereither directly or indirectly through intervening structures, as well asboth movable or rigid attachments or relationships, unless expresslydescribed otherwise.

The term “trigger finger,” as used herein, also refers to “triggerdigit,” “trigger thumb,” and “stenosing tendovaginitis.”

As used herein, the terms “horizontal” and “vertical,” and derivativesof those terms, are used in respect to their relationship to the planedefined by the slot in the cannula of the present application.“Vertical” refers to the plane that can, for example, pass through theslot of the cannula and bisect the cannula into two equal halves, while“horizontal” refers to a plane that is perpendicular to the verticalplane. The horizontal plane may be a level plane with respect to thelength of the cannula or housing of the device, or may be at an angle tothat level plane, allowing some upward or downward movement of elementsmoving along the horizontal plane with respect to the level plane.

The present application describes a compact device for performingendoscopic surgical procedures, comprising a clear cannula that isattached to a housing. The cannula has a closed distal end, allowing thecannula to be inserted through a portal (such as an incision) withoutthe use of a cannula filling instrument, such as an obturator. Thehousing further comprises a blade that extends into the cannula, and apaddle for pushing the blade. In some embodiments, the housing furthercomprises a ring that secures the paddle to the housing, but allows thepaddle to rotate side-to-side. The present assembly provides aconvenient means for performing endoscopic surgical procedures with theelimination of the steps of inserting an obturator into the cannula forintroducing the cannula into a portal, removing the obturator from thecannula, and removing an endoscope from the cannula so that a blade canbe inserted and advanced into the cannula. The preassembled nature ofthe device also provides convenience for the practitioner in that thecannula and blade are available in a single package that requires nofurther assembly and can be used easily in an office setting without theneed for some traditional endoscopic equipment that may be too expensiveor cumbersome to use outside of a hospital. Additionally, the presentdevice also can be easily transported and used in remote settings, suchas by emergency medical personnel, first responders or military medicalpersonnel.

The use of the present device is exemplified in this application for,but not limited to, endoscopic surgical division of a pulley or tunnel.Some other non-limiting uses for the present device include, forexample, other divisions or partial separation of a tendon or ligament,cutting, dividing, separating or making an incision in connectivetissue, muscle, cartilage, membranes, skin, other body tissues or organsor any other use of the device that can be envisioned or carried out bythe practitioner. As used herein, the term “practitioner” refers to oneof skill in the art or any other user of the present device.

Endoscopic surgical procedures that can be performed with a device ofthe present application include, but are not limited to, carpal tunnelrelease, Guyon's tunnel (or canal) release, cubital tunnel release,plantar fascia release, lateral release for patella realignment, releaseof radial tunnel, release of pronatar teres, release of trigger finger,release of lacertus fibrosus, release of the extensor tendons forlateral epicondylitis, release of medial epicondylitis, release of theposterior and other compartments of the leg, forearm fascia release forfascial compartment syndrome, release of fascial compartments in theupper or lower extremities, relieving the compression of a nerve by aligament pulley or tunnel, and releasing the travel of a ligamentthrough a ligament pulley or tunnel.

One aspect of the present application relates to an endoscopic surgicaldevice, comprising: (a) a housing having a proximate end and a distalend; (b) a slotted clear cannula attached to said distal end of saidhousing, said slotted clear cannula comprises a cannula body having aproximate end and a distal end, and a slot extending from said proximateend of said cannula to the proximity of said distal end of said cannula;(c) a revolver assembly located within said housing, comprising: a slidelock having a proximate end, a distal end and two notches at said distalend; a scraper; a blade assembly; and a circular revolver bodycomprising a selector switch; wherein said scraper and said blade resideat said two notches of said slide lock in a pre-deployment position andwherein said selector switch allows selection of said scraper or saidblade for deployment; and (d) a tube assembly having a proximate end anda distal end, said distal end of said tube assembly is located withinsaid housing and extends through said revolver, said tube assembly iscapable of entering said slotted clear cannula from said proximate endof said clear cannula.

In one embodiment, the end of the slotted clear cannula distal to thehousing is closed. In a further embodiment, the closed end of thecannula is tapered.

In another embodiment of the endoscopic surgical device, said housingfurther comprises a stabilizing ring that mounts into said proximate endof said housing.

In another embodiment, the endoscopic surgical device further comprisesa rotary clip that prevents said scraper and said blade from sliding inundeployed positions. In a further embodiment, said rotary clipcomprises a tab that engages with an inside surface of said housing andan opening that allows deployment of said scraper or said blade.

In another embodiment of the endoscopic surgical device, said circularbody of said revolver comprises a hooked tab that engages with saidslide lock. In a further embodiment, said circular body of said revolverfurther comprises a set of upper tabs and a set of lower tabs, whereinsaid upper tabs and said lower tabs extend inwardly from an interiorsurface of said circular body.

In still another embodiment of the endoscopic surgical device, saidslide lock comprises a tab located between said two notches at saiddistal end. In a further embodiment, said slide lock further comprisesone or more retaining tabs that hold a rotary clip.

In yet another embodiment of the endoscopic surgical device, said slidelock comprises a pair of wings that engage with said revolver. In afurther embodiment, said slide lock further comprises a disc at saidproximate end of said slide lock.

In yet still another embodiment of the endoscopic surgical device, saidtube assembly comprises a tool selector at said distal end of said tubeassembly. In a further embodiment, said tool selector is welded ontosaid tube assembly. In another further embodiment, said tube assemblyfurther comprises a tube stop at said proximate end of said tubeassembly.

In still another embodiment of the endoscopic surgical device, saidblade assembly comprises a pusher base and a cutting blade. In a furtherembodiment, said pusher base comprises a notch that is capable ofengaging with a tool selector on said tube assembly. In another furtherembodiment, said cutting blade comprises a tab that embeds into saidpusher base. In still another further embodiment, said cutting bladecomprises an upper cutting surface that forms an upper angle with abottom surface of said cutting blade. In a further embodiment, saidupper angle is between about 30 and about 45 degrees. In yet anotherfurther embodiment, said cutting blade further comprises a lower cuttingsurface that forms a lower angle with a bottom surface of said cuttingblade. In a further embodiment, said lower angle is between about 45 andabout 65 degrees.

In yet another embodiment of the endoscopic surgical device, saidscraper comprises a notch that is capable of engaging with a toolselector on said tube assembly.

Another aspect of the present invention relates to an endoscopicsurgical kit, comprising an endoscope and an endoscopic surgical device,comprising: (a) a housing having a proximate end and a distal end; (b) aslotted clear cannula attached to said distal end of said housing, saidslotted clear cannula comprises a cannula body having a proximate endand a distal end, and a slot extending from said proximate end of saidcannula to the proximity of said distal end of said cannula; (c) arevolver assembly located within said housing, comprising: a slide lockhaving a proximate end, a distal end and two notches at said distal end;a scraper; a blade assembly; and a circular revolver body comprising aselector switch; wherein said scraper and said blade reside at said twonotches of said slide lock in a pre-deployment position and wherein saidselector switch allows selection of said scraper or said blade fordeployment; and (d) a tube assembly having a proximate end and a distalend, said distal end of said tube assembly is located within saidhousing and extends through said revolver, said tube assembly is capableof entering said slotted clear cannula from said proximate end of saidclear cannula.

In another embodiment, the kit further comprises a scalpel.

In yet another embodiment, the kit further comprises a blunt instrumentfor tissue separation. In a still further embodiment, the bluntinstrument is an elevator.

Another aspect of the present invention relates to a method for aperforming a uniportal endoscopic surgical procedure on a target tissueusing an endoscopic surgical device, comprising: (a) a housing having aproximate end and a distal end; (b) a slotted clear cannula attached tosaid distal end of said housing, said slotted clear cannula comprises acannula body having a proximate end and a distal end, and a slotextending from said proximate end of said cannula to the proximity ofsaid distal end of said cannula; (c) a revolver assembly located withinsaid housing, comprising: a slide lock having a proximate end, a distalend and two notches at said distal end; a scraper; a blade assembly; anda circular revolver body comprising a selector switch; wherein saidscraper and said blade reside at said two notches of said slide lock ina pre-deployment position and wherein said selector switch allowsselection of said scraper or said blade for deployment; and (d) a tubeassembly having a proximate end and a distal end, said distal end ofsaid tube assembly is located within said housing and extends throughsaid revolver, said tube assembly is capable of entering said slottedclear cannula from said proximate end of said clear cannula, comprising:establishing an entry portal in said subject, inserting into said entryportal said cannula of said endoscopic surgical device; extending saidcannula through said entry portal to said target tissue; advancing anendoscope into said cannula visualize a target tissue; and advancingsaid blade into said cannula until a desired cut is made on said targettissue.

In one embodiment, the establishing an entry portal comprises making anincision.

In one embodiment, an endoscope is inserted through the housing and intothe cannula to view the target tissue and the surrounding tissues,assuring that the slot of the cannula is in proper orientation to thetarget tissue.

In a further embodiment, the knife is advanced through the cannula sothat the blade moves in contact with the target tissue through the slot,operatively engaging the target tissue with the blade. In a stillfurther embodiment, the desired cut is division of the target tissue.

In a particular embodiment, the method further comprises advancing saidscraper into said cannula to remove tenosynovium.

In another particular embodiment of the method, the uniportal endoscopicsurgical procedure is selected from the group consisting of triggerfinger release, carpal tunnel release, cubital tunnel release, plantarfascia release, lateral release for patella realignment, release of theextensor tendons, release of the posterior or other compartments of theleg, and forearm fascial release.

In still another particular embodiment of the method, the target tissueis selected from the group consisting of the A1 pulley, carpal tunnel,cubital tunnel and Guyon's tunnel.

Linear Operated Device

FIG. 1 shows an exemplary device of the present application. The devicecomprises a blade 10, a slotted clear cannula 20, and a housing 30. Thedevice may further include a pusher paddle 40, and may still furtherinclude a retainer ring 50.

The blade 10 comprises a horizontally-oriented pushing component 11 anda vertically-oriented cutting component 12. The cutting component 12further comprises a sharpened cutting surface 13 at the forward end,which is the end of the blade most proximal to the cannula 20 of thedevice. The cutting surface 13 may be single-beveled or double-beveled.

In some embodiments, the cutting surface 13 of the blade is a singlecutting surface. In some further embodiments, that single cuttingsurface is angled downward such that the upper end of the cuttingsurface is forward of the lower end of the cutting surface. In otherfurther embodiments, that single cutting surface has a concave curve andis semi-circular or crescent shaped.

In other embodiments, the cutting surface 13 of the cutting component 12is divided into an upper cutting surface and a lower cutting surfacethat are at an angle to one another and meet at a central crotch.

The design of the present blade 10 is such that it is usable inendoscopic surgery in a manner that allows the practitioner to extendthe blade 10 through the cannula to the target tissue without damage tosurrounding tissue and/or organs. The cutting component 12 of blade 10is made from materials commonly used for surgical blades or scalpels,such materials include, but are not limited to, hardened and temperedsteel, stainless steel, high carbon steel, titanium, alloys and ceramic.

In particular embodiments, the cutting component 12 of the blade 10 ismade from stainless steel. In a further embodiment, the stainless steelis martensitic stainless steel. An exemplary martensitic stainless steelis Bohler-Uddeholm AEB-L martensitic stainless steel. In a still furtherembodiment, the martensitic stainless steel is heat-treated. In anotherfurther embodiment, the stainless steel is 440 A stainless steel. In aparticular embodiment, the cutting component 12 of the blade 10 is madefrom Hitachi GIN-5 SST-MODIFIED 440-A stainless steel. The cuttingcomponent 12 of the blade 10 is optionally flash electropolished. Thecutting edges are machine finished and must be sharp. In a particularembodiment, the steel of the cutting component 12 of the blade 10 isheat-treated to Rockwell C hardness of about 50-72. In a more particularembodiment, the steel of the cutting component 12 of the blade 10 isheat-treated to Rockwell C hardness of 58-64.

In particular embodiments, the entire blade 10 is cut from a singlesheet of, or is cast from, a material commonly used for surgical bladesor scalpels. The cutting component 12 is then bent into a verticalorientation that is perpendicular to the horizontal orientation of thepushing component 11. In some embodiments, the bevel(s) of the cuttingsurface 13 are ground prior to bending. In other embodiments, thebevel(s) of the cutting surface 13 are ground after bending.

In other embodiments, the pushing component 11 and cutting component 12of the blade 10 are fabricated separately (by cutting or casting) andaffixed to one another in their respective proper orientations. In somefurther embodiments, the pushing component 11 and cutting component 12are fabricated from the same material. In other further embodiments, thepushing component 11 and cutting component 12 are fabricated fromdifferent materials, but at least the cutting component 12 is fabricatedfrom a material commonly used for surgical blades or scalpels. In such acase, the pushing component 11 of the blade 10 may be fabricated fromany suitable material providing adequate strength and rigidity forpushing the cutting component including, but not limited to, plastics,polycarbonate, hardened and tempered steel, stainless steel, high carbonsteel, titanium, alloys and ceramic. Affixing of the cutting component12 to the pushing component 11 may be accomplished by any means known inthe art, such as the use of a suitable adhesive or by welding, includinglaser welding. In a particular embodiment, the strength of the bondbetween the pushing component 11 and the cutting component 12 is testedby applying torque to the unit, for example about 10 in-lbs of torque.

In particular embodiments, the blade 10 further comprises tabs 14 at theend of the pushing component 11 distal to the cutting component 12. Insome embodiments, the tabs 14 extend outward to the sides of the blade10 in the same horizontal plane as the pushing component 11, although insome embodiments, the tabs 14 may also be at an angle to that horizontalplane, as appropriate for the application. As used herein, the term“tabs” refers to either a single tab structure, two tab structures, orany other multiple as appropriate.

The tabs 14 are slidably engaged with the case or housing 30 in a mannerto be further described below.

The cannula 20 is made of a clear plastic material so that the entiretyof the surrounding tissue can be viewed with an endoscope. The cannula20 is slotted along its top, with the slot 21 being contiguous with theopen end 22 that is proximal to the housing 30. in some embodiments, thedistal end 23 of the cannula 20 is closed, such that the cannula 20 canbe inserted into a channel made through body tissue without the use ofan obturator. In particular embodiments, the closed distal end 23 of thecannula is tapered, but is sufficiently blunted such that it does notdamage bodily tissues as it is advanced though an incision and channelthrough bodily tissue, or through a natural body opening.

The cannula 20 engages with the blade 10 of the device such that thecutting component 12 inserts into and is slidably engaged with the slot21.

In some embodiments, the cannula 20 further internally compriseshorizontal blade guidance tracks 24 perpendicular to the plane of andbelow the slot 21. The sides 15 of the pushing component 11 of the blade10 slidably engage with the horizontal blade guidance tracks 24, inorder to allow the accurate advancement of the cutting component 12 ofthe blade 10 through the slot 21. In some further embodiments, theheight of the horizontal blade guidance tracks 24 is level with respectto the distance from the slot 21, such that the distance the cuttingsurface 13 protrudes through the slot 21 is the same over the entirecourse of travel from the proximal end 22 of the cannula 20 to thedistal end 23 of the cannula 20. In other further embodiments, theheight of the horizontal blade guidance tracks 24 is at an angle withrespect to the distance from the slot 21, such that the distance thecutting surface 13 protrudes through the slot 21 is lower at or near theproximal end 22 of the cannula 20 and higher at or near the distal end23 of the cannula 20.

In some embodiments, the cannula 20 further comprises a channel 25 forthe slidable insertion a viewing device, such as an endoscope. In someembodiments, the channel 25 is located below the horizontal bladeguidance tracks 24. In some embodiments, the channel 25 and thehorizontal blade guidance tracks 24 form a single contiguous lumen thatis also contiguous with the slot 21. In other embodiments, there is alayer of material molded as part of the cannula 20 between the channel25 and the horizontal blade guidance tracks 24, such that the lumen ofthe channel 25 is physically separate from the lumen contiguous with theslot 21 and comprising the horizontal blade guidance tracks 24.

In some embodiments, the proximal end 22 of the cannula 20 is adapted toengage with a connection point 31 on the front end of the housing 30.The attachment can be by any means known in the art, such as, but notlimited to, adhesives, tabs, welds, laser welds, locking mechanism,twist-lock, or friction fitting. In order to provide a stable platformfor endoscopic surgical procedures using the device, the attachment ofthe cannula 20 to the housing 30 is such that, when assembled, thecannula 20 cannot move in relation to the housing 30.

In some embodiments, the housing 30 of the device comprises two halves32, 33 that mate to one another to form a single housing 30. In someembodiments, the housing 30 may be formed as a single piece or comprisethree or more pieces.

The interior of the housing 30 comprises a guidance slot 34 on each sideof the housing such that the two guidance slots 34 are horizontallyopposed to one another. The tabs 14 of the blade 10 are slidably engagedwith the horizontally opposed guidance slots 34. In some embodiments,the height of the horizontally opposed guidance slots 34 is parallel towith respect to a horizontal plane that would bisect the cannula 20 intotwo equal halves. In other embodiments, the height of the horizontallyopposed guidance slots 34 is at an angle with respect to a horizontalplane that would bisect the cannula 20 into two equal halves, such thatthe end of the horizontally opposed guidance slots 34 distal to thecannula 20 is lower in the device with respect to the end of thehorizontally opposed guidance slots 34 proximal to the cannula 20.

When the tabs 14 are drawn back in the horizontally opposed guidanceslots 34, the cutting component 12 is contained within the proximate end22 of the slot 21 of the cannula 20 and the cutting surface 13 is notprotruded outside the device. As the tabs 14 are advanced in thehorizontally opposed guidance slots 34 toward the connection point 31with the cannula 20, the cutting component 12 slides in the proximatedirection of the slot 21 of the cannula 20 and moves the cutting surface13 toward the proximate end 23 of the cannula 20.

In some embodiments, the device comprises a paddle 40 that contacts theblade 10 behind or between the tabs 14. The paddle 40 comprises a griparea 41 that protrudes out of the housing 30 through a slot 35. Theblade 10 is slidably advanced along the horizontally opposed guidanceslots 34 by advancing the paddle 40 towards the cannula 20 through theslot 35, causing the contact area 42 of the paddle 40 to push againstthe pushing component 11 of the blade 10.

In some embodiments, the paddle 40 comprises at least one arm thatextends forward of the tabs 14 that allows the paddle 40 to capture thetab 14 and pull the blade 10 back to a withdrawn position followingcompletion of an endoscopic surgical procedure.

In some embodiments, the paddle 40 is secured in the device by aretaining ring 50. The retaining ring 50 comprises wings 51 thatslidably interact with the horizontally opposed guidance slots 34 of thehousing 30. The retaining ring 50 further comprises an attachment ring52 that connects to the connection region 43 of the paddle 40. Theconnection region 43 of the paddle 40 may comprise any means known inthe art for connecting the paddle 40 to the retaining ring 50. Forexample, the connection region 43 may comprise tabs that extend throughand entrap the attachment ring 52. In some embodiments, the connectionbetween the connection region 43 and the attachment ring 52 allows thepaddle 40 to rotate side-to-side in relation to the retaining ring andthe blade 10.

In some embodiments, the paddle 40 can be retained, parked or locked ina position fully distal to the cannula 20 by rotating the grip area 41of the paddle 40 into, for example, a notch 36 in the housing 30.

In some embodiments, the housing 30 further comprises an opening 39 atthe end distal to the cannula 20 through which an endoscope can beinserted. The endoscope is fed through the opening 39 and under theblade 10 to be inserted into the channel 25 of the catheter 20, thisallows direct visualization of the surgical site and the surroundingtissue before, during and after performing an endoscopic surgicalprocedure with the present device.

Another aspect of the present application relates to a slotted clearcannula having a closed end such that the cannula can be inserted intoan incision or natural body opening and into a passage through bodytissue without the use of a device, such as an obturator, filling thelumen of the cannula for insertion. In particular embodiments, theclosed end of the cannula is tapered, but is sufficiently blunted suchthat it does not damage bodily tissues as it is advanced though anincision and channel through bodily tissue, or through a natural bodyopening. In another particular embodiment, the slot is contiguous withthe open end of the cannula opposite the closed end.

Rotationally Operated Devices

FIGS. 2 and 3 show embodiments of the present application wherein thedevice comprises a rotational switch for selecting the tool to advanceinto the cannula. FIG. 2 shows an embodiment comprising selectionpositions for advancing the endoscope alone into the cannula and foradvancing a blade along the endoscope into the cannula. FIG. 3 shows analternate embodiment, wherein the device further comprises a selectablescraper that can be advanced along the endoscope into the cannula.

FIG. 4 depicts an exploded view of the present device of FIG. 3. Thehousing 30 is cylindrical in shape and is comprised of two halves 32,33.The proximal end 22 of the cannula 20 is adapted to engage with aconnection point 31 on the front end of the housing 30. In someembodiments, the proximal end 22 of the cannula 20 comprises depressions26 that engage with tabs (or pins) 37 at the connection point 31 on thefront end of the housing 30. As used herein, the term “depression” isunderstood to include, but is not limited to, depressions that do notpenetrate completely through the material of the cannula, as well asholes or slots that penetrate completely through the material of thecannula.

The housing 30 further includes an opening 38 that can be located ineither half 32,33 of the housing. in some embodiments, the opening 38may span the junction between the halves 32,33 of the housing 30, beinglocated partially in each half. The opening 38 is located adjacent to aninternal revolver 60 that comprises a selector switch 61 that protrudesthrough the opening 38.

Still referring to FIG. 4, the device further comprises an slide lock 70(or inner sleeve 70) that encircles a guidance tube or tube assembly 71.The slide lock 70 comprises notches 72,73 and a tub 79 separating thenotches 72,73, at its distal end that provide pre-deployment restingplaces for a blade 80 and a scraper 90. The slide lock 70 works inconcert with the revolver 60 in order to bring the blade 80 or scraper90 into the proper orientation for deployment into the slot 21 of thecannula 20. The tube assembly 71 provides a path for deploying anendoscope through the device and into the cannula 20. The tube assembly71 also provides, at its distal end, a mounting point or tube locator 78(shown in FIG. 8A) that the blade 80 or scraper 90 is rotated onto fordeployment. At the proximate end of the housing, the tube assemblypasses through a stabilizer ring 74, which mounts into, and seals, theproximate end of the housing. The tube assembly 71 is advanced along thedeployed endoscope into the cannula 20, thereby deploying the blade 80or scraper 90 into the slot 21 of the cannula 20.

Turning to FIG. 5, a number of components of the device depicted in FIG.3 are shown separately from one another. It is understood that theindividual elements of the device are not limited to the exactconfiguration depicted in the figures herein. Any design of particularelements of the device that can be envisioned by one of ordinary skillin the art to perform the same function in concert with other elementsis included as part of the present disclosure.

Also in FIG. 5, the blade 80 comprises a base 81 that allows the blade80 to be secure in its pre-deployment notch 72 of the slide lock 70.When the blade 80 is rotated into deployment orientation, the notch 82in the base 81 engages the mounting point 78 (shown in FIG. 8A) on thedistal end of the guidance tube 71. As the blade 80 is distally deployedinto the slot 21 of the cannula 20, the base 81 retains the blade 80 inthe device by underlapping the sides of the slot 21 within the channel25 of the cannula 20. Additionally, to prevent any unwanted side-to-sidemotion of the blade 80 as it is deployed distally through the slot 21 ofthe cannula 20, in some embodiments the blade further comprises a ridge83 that fills the slot side-to-side. Additionally, the engagement of thenotch 82 with the mounting point 78 allows the blade 80 to be safelyretracted back into the housing 30 following usage of the blade 80 foran endoscopic surgical procedure.

Still referring to FIG. 5, the scraper 90 comprises a base 91 thatallows the scraper 90 to be secure in its pre-deployment notch 73 of theslide lock 70. When the scraper 90 is rotated into deploymentorientation, the notch 92 in the base 91 engages the mounting point 78(shown in FIG. 8A) on the distal end of the guidance tube 71. As thescraper 90 is distally deployed into the slot 21 of the cannula 20, thebase 91 retains the scraper 90 in the device by underlapping the sidesof the slot 21 within the channel 25 of the cannula 20. Additionally,the engagement of the notch 92 with the mounting point 78 allows thescraper 90 to be safely retracted back into the housing 30 followingusage of the scraper 90 for an endoscopic surgical procedure.

Turning to FIG. 6, a cutaway drawing is shown that depicts the passageof the guidance tube or tube assembly 71 through the slide lock 70 andinto the cannula 20.

FIG. 7 is a cutaway drawing showing an exemplary relationship of theslide lock 70 to the revolver 60 of the device. The slide lock 70extends into the revolver 60 and the pre-deployment slots 72,73 holdingthe blade 80 and the scraper 90 are located inside the revolver 60. Inan exemplary configuration, springs 75 are attached to pins 76 locatedon the revolver 60. The springs 75 extend to pins 77 that secure theopposite end of the springs to the slide lock 70. The springs 75 autocenter the revolver 60 within the device. Upon rotation of the revolver60, the springs 75 activate detents for the three modes: 1) deploymentof the endoscope, 2) orientation of the scraper 90 in deploymentconfiguration, and 3) orientation of the blade 80 in deploymentconfiguration.

FIGS. 8A-F show the rotation of the slide lock corresponding to thethree modes. FIG. 8A, viewing from above, and 8B, viewing from a distalposition, are a depiction of the first mode, wherein the an endoscope100 can be advanced through the guidance tube 71 into the cannula 20,without the deployment of the scraper 90 or the blade 80. The mountingpoint 78 is not engaged with either the blade 80 or the scraper 90,therefore preventing the deployment of either tool in this mode.

FIG. 8C, viewing from above, and 8D, viewing from a distal position, area depiction of the second mode, wherein the revolver 60 has been turnedto select the scraper 90. the slide lock 70 is rotated in concert withthe revolver 60 to bring the scraper 90 into deployment orientation. Theslot 92 in the base 91 of the scraper 90 is rotated to engage themounting point 78 on the guiding tube (hidden). The guiding tube is thenpushed distally into the cannula 20 with the scraper 90 protrudingthrough the slot 21. Following use of the scraper 90, the guiding tubeis retracted from the cannula 20 and the revolver 60 is returned to thefirst mode, restoring the scraper to its pre-deployment configuration ofFIGS. 8A-B.

FIG. 8E, viewing from above, and 8F, viewing from a distal position, area depiction of the third mode, wherein the revolver 60 has been turnedto select the blade 80. The slide lock 70 is rotated in concert with therevolver 60 to bring the blade 80 into deployment orientation. The slot82 in the base 81 of the blade 80 is rotated to engage the mountingpoint 78 on the guiding tube (hidden). The guiding tube is then pusheddistally into the cannula 20 with the blade 80 protruding through theslot 21. Following use of the blade 80, the guiding tube is retractedfrom the cannula 20 and the revolver 60 is returned to the first mode,restoring the blade 80 to its pre-deployment configuration of FIGS.8A-B.

FIG. 9 is a perspective view from above an embodiment of the deviceshowing, in particular, the cannula 20, housing 30 and tube assembly 71as they appear in the assembled device prior to deployment of the tubeassembly 71 into the cannula 20 with the scraper tool or blade assembly.

FIG. 10 is an exploded view of the embodiment of the device shown inFIG. 9. FIG. 10 shows the cannula 20 which joins to the distal end oftop half 32 and bottom half 33 of the housing 30. Interior to thehousing 30 is the revolver 60, having a selector switch 61 for choosingthe “BLADE,” “SCOPE,” or “SCRAPER” position of the slide lock 70, whichis positioned inside the revolver 60. The blade 80 and scraper 90 toolsare parked in notches 72,73 in the slide lock 70 and are retained therewhen not deployed by a rotary clip 170. The tube assembly 71 passesthrough the slide lock 70 within the housing 30. The distal end of thetube assembly 71 extends and is deployable into the cannula 20. The tubeassembly 71 comprises near its distal end a tube locator 78 that theblade 80 or scraper 90 tool is engaged with for deployment into thecannula 20. The tube assembly 71 further comprises, at its proximateend, a tube stop 84 that prevents the proximate end of the tube assembly71 from passing through the stabilizer ring 74 mounted in the rear ofthe housing 30. The tube assembly 71 has a longitudinal central lumenthat accommodates the insertion of an endoscope through the tubeassembly 71 and into the clear cannula 20 in order to visualize thetissue surrounding said cannula 20 and to observe the surgical procedureperformed with the compact endoscopic surgical device. In someembodiments, the tube stop 84 is gripped by the practitioner or engagedto a grippable attachment 300 (FIG. 9) to allow the tube assembly to beoperated manually for advancement or withdrawal of the tube assembly 71.In other embodiments, the tube stop 84 is engaged to an apparatus ormachine for automatic or remote control of advancement or withdrawal ofthe tube assembly 71.

FIGS. 11A-E show details of the clear cannula element of the device.FIG. 11A shows the cannula 20 from the top, showing the slot 21extending longitudinally from the proximity of the proximal end 22 tothe proximity of the distal end 23. Also visible are the depressions,slots, or holes 26 that engage with tabs or pins on the front of thehousing. In some embodiments, the sides of the slot 21 comprise textureor tick marks 27 that are at a measured distance from one another downthe length of the slot 21. The tick marks 27 minimally engage with thecarrier of the blade and/or scraper as it advances, or retreats, alongthe length of the slot 21 to allow the practitioner to feel, orotherwise determine, how far the carrier has advanced along the slot. Insome embodiments, the distal end 23 of the cannula 20 is blunted andserves as an obturator.

FIG. 11B shows a side view of the cannula 20, showing the proximate 22and distal 23 ends, as well as the depressions, slots, or holes 26 thatengage with tabs or pins on the front of the housing. In someembodiments, the distal end 23 of the cannula is angled upwards, as anobturator.

FIG. 11C depicts an angled view of the clear cannula 20 of the device.In some embodiments, the depressions, slots, or holes 26 that engagewith tabs or pins on the front of the housing are located on the top andbottom of the proximate end 22 of the cannula. In some embodiments,rather than individual or multiple depressions, slots, or holes 26 onthe top, bottom or sides of the cannula 20, the depression 26 may be animpression or groove that runs all the way around the outside of theproximate end 22 of the cannula 20 and engages with an annular ring thatruns around the inside of the distal end of the housing.

FIG. 11D shows an end view of the cannula at the proximate end 22. Theview shows the slot, which is contiguous with the central lumen 28 ofthe cannula. FIG. 11E is a cross-sectional view of the cannula 20 atbisecting line A-A in FIG. 11A, looking towards the proximate end of thecannula 20. The longitudinal slot 21 in the top surface of the cannula20 can be seen to be contiguous with the central lumen of the cannulatube 20.

FIGS. 12A-F show various views of the top half 32 of the housing 30.FIG. 12A shows the outside of one embodiment of the top half 32 of thehousing 30 at an angle, while FIG. 12B shows the inside of oneembodiment of the top half 32 of the housing 30 at an angle. FIG. 12Cshows the inside of one embodiment of the top half 32 of the housing 30,showing one embodiment of a tab or pin 37 that engages with adepression, slot, or hole located on the proximate end of the cannulashown in FIGS. 11A-E. In some embodiments, rather than individual ormultiple tabs or pins at the distal end of the housing, the tab 37 maybe an annular ring that runs around the inside of the distal end of thehousing 30 and engages an impression or groove that runs all the wayaround the outside of the proximate end of the cannula. FIG. 12D showsthe upper half 32 of the housing 30 from a side view, while FIG. 12Eshows a view of the top half 32 of the housing 30 from the distal endand FIG. 12F shows a view of the top half 32 of the housing 30 from theproximate end.

FIGS. 13A-F show various views of the lower half 33 of the housing 30.FIG. 13A shows the outside of one embodiment of the lower half 33 of thehousing 30 at an angle, while FIG. 13B shows the inside of oneembodiment of the lower half 33 of the housing 30 at an angle. FIG. 13Cshows the inside of one embodiment of the lower half 33 of the housing30. FIG. 13D shows the lower half 33 of the housing 30 from a side view,while FIG. 13E shows a view of the lower half 33 of the housing 30 fromthe distal end and FIG. 13F shows a cross-sectional view looking towardsthe distal end of the lower half 33 of the housing 30 from the line A-Abisecting FIG. 13C.

FIGS. 14A-E show detailed views of an embodiment of the revolver 60element of the device. FIG. 14A is an exterior perspective view of therevolver 60, showing a selector switch 61 that protrudes through theopening 38 (FIG. 4) in the housing, as well as the proximate 63 anddistal 64 ends of the revolver 60 element. The selector switch 61 isrotated from side to side by the user to select the appropriateinstrument for a particular step in an endoscopic surgical procedure.FIG. 14B is a top view of the rotator 60 with the selector switch 61.

FIG. 14C is a view of the distal 64 end of the revolver 60. In someembodiments of the device, the revolver 60 comprises upper tabs 65 andlower tabs 66 that are used to select the scraper 90 or blade assembly190 of the device. For example, when the selector switch 61 is rotatedby the user to the position marked “SCRAPER” (see FIG. 3, for example),the tabs 65 and 66 engage the scraper 90 and move it to the centerline(here, line A-A in FIG. 14C) of the device. There, the scraper 90 isengaged by a tab on the tube (71 in FIG. 4, for example) of the device,so that it can be deployed into the cannula 20 (FIG. 4) and protrudethrough the longitudinal slot 21 (FIG. 4) therein. When the selectorswitch 61 is rotated by the user to the position marked “BLADE” (seeFIG. 2, for example), the tabs 65 and 66 engage the blade assembly 190and move it to the centerline (here, line A-A in FIG. 14C) of thedevice. There, the blade assembly 190 is engaged by a tab on the tube(71 in FIG. 4, for example) of the device, so that it can be deployedinto the cannula 20 (FIG. 4) and protrude through the longitudinal slot21 (FIG. 4) therein. However, when the selector switch 61 is rotated bythe user to the position marked “SCOPE” (see FIG. 2, for example), thetabs 65 and 66 retain the scraper 90 and blade assembly 190 in theirparked positions out of the centerline so that an endoscope, or otherdevice, can be advanced through the tube 71 (FIG. 4) into the cannulawithout either the scraper tool or blade assembly being advanced.

FIG. 14D is a cross-sectional view of revolver 60 at line B-B in FIG.14B and looking in the direction of the proximate end 63 of the revolver60. FIG. 14E is also a cross-sectional view of the revolver 60, thistime along centerline A-A of FIG. 14C. As can be seen in this view, insome embodiments of the device, the revolver 60 comprises a hooked tab68 that engages the front of the tab 79 that separates the notches (72,73 in FIG. 10) in the slide lock 70 (see FIG. 15) that hold the scraper90 and blade assembly 190. When the selector switch 61 is in the “SCOPE”position, for example, the hooked tab 68 helps ensure that neither thescraper tool nor blade assembly can be deployed into the cannula.

Turning to FIGS. 15A-E, shown is an embodiment of a slide lock 70 of thedevice. FIG. 15A shows the slide lock 70 from an angled perspective. Theslide lock 70 comprises two notches 72,73 that hold the scraper 90 andblade assembly 190 in place when they are parked, as well as rotate theminto the ready position when they are selected for use by rotation ofthe revolver 60 (FIGS. 14A-E, for example). The two notches 72,73 areseparated from one another by the tab 79. The front of the tab 79engages with the hooked tab 68 (FIG. 14E, for example) of the revolver60 when the selector switch 61 is not lined up with the “SCRAPER” or“BLADE” options, thus preventing the scraper 90 or blade assembly 190from being deployed into the cannula when not in use. In someembodiments, the slide lock 70 comprises retaining tabs 171,172 thathold a rotary clip 170 (FIGS. 16A-E, for example) in place, preventingthe rotary clip from sliding forward or backward on the slide lock 70.The rotary clip 170 does not rotate with the revolver 60 and slide lock70, serving to prevent the scraper 90 or blade assembly 190 from slidingforward out of their notches 72,73 when they are not selected. Someembodiments of the slide lock 70 further comprise a pair of wings174,175 that engage with the revolver 60 (FIGS. 14A-E, for example) forturning the slide lock 70 when a particular tool, such as “SCRAPER,”“BLADE” or “SCOPE” is selected. Some embodiments of the slide lock 70further comprise a disc 176 at the proximate end. The outer rim of thedisc 176 contacts the inside surface of the housing 30 (FIG. 10) toallow the slide lock 70 to rotate, but prevents or constrainsside-to-side or up-down movement of the slide lock in the device.

Still referring to FIG. 13, FIG. 15B is a side view of the slide lock70. In some embodiments, the retaining tabs 171,172 are matched byidentical or similar retaining tabs on the other side of the slide lock70. FIG. 15C shows an end view of slide lock 70, looking from the distalend towards the disc 176 at the proximate end. The center lumen 173 ofthe slide lock 70 allows the passage of the tube assembly 71 through theslide lock 70 and into the cannula 20 (FIG. 10). FIG. 15D is aperspective view of the slide lock 70 from the top, while FIG. 15E is alongitudinal cross-section view at line A-A through FIG. 15D.

Turning now to FIGS. 16A-E, perspective views of an embodiment of arotary clip 170 of the device are presented. FIG. 16A shows the rotaryclip 170 from an angle. In some embodiments, the rotary clip 170comprises a tab 177 that engages with the inside of the housing 30 (FIG.10) to prevent the rotary clip 170 from rotating or sliding. The top ofthe rotary clip 170 is open, so that when the scraper tool or bladeassembly is rotated into the deployment position, it can be deployedthrough the rotary clip 170 and into the cannula 20 (FIG. 10). FIG. 16Bis a perspective view of the rotary clip 170 as viewed from the distalside towards the proximate side. FIG. 16C is a side perspective view ofthe rotary clip 170. In some embodiments, a portion of the distal sideof the rotary clip 170 may be notched 179. FIG. 16D is a perspectiveview of the rotary clip 170 looking down upon the top. The rotary clipmay be manufactured from any suitable material, such as plastic,stainless steel, aluminum, or metal alloys. In some embodiments, therotary clip 170 may be formed, cut, stamped, cast or milled as a flatpiece, as shown in FIG. 16E, from a malleable metal such as SS 303 andthen formed into the final shape of being an open-topped ring with a tabat the bottom as shown in FIG. 16A. In other embodiments, the rotaryclip 170 may be formed, cut, molded, 3D-printed, cast or milled from asuitable material as an open-topped ring with a tab at the bottom asshown in FIG. 16A.

FIGS. 17A-D show an embodiment of a tube assembly 71 of the device. Insome embodiments, the tube assembly is composed of stainless steel,preferably AISI 304 stainless steel. However, the tube assembly can bemade from any suitable material including, but not limited to, aluminum,titanium, nitinol or other metal alloys, or plastic. In some embodimentswhere the tube assembly 71 is made of plastic, the plastic may be clear,allowing visualization with an endoscope of tissues surrounding thecannula 20 through the body of the tube assembly 71.

FIG. 17A is a top view of the tube assembly 71. The body of the tubeassembly 71 slides through the center lumen 173 of the slide lock 70.The tube assembly 71 comprises near its distal end a tool selector 78.The tool selector 78 is directly on top of the tube assembly 71. Withreference to FIGS. 9 and 10, when the selector switch 61 of the revolver60 is positioned at the “SCOPE” setting, no tools are engaged with thetool selector 78 and the tube assembly 71 can be advanced into thecannula 20 without the blade assembly 190 or scraper 90. When theselector switch 61 of the revolver 60 is mover to the “BLADE” setting,the revolver 60 rotates the slide lock 70 such that the notch 72 holdingthe blade assembly 190 is moved to the top of the tube assembly 71 andthe notch in the bottom surface of the blade assembly 190 is positivelyengaged with the tool selector 78. Advancement of the tube assembly 71would cause the advancement of the blade assembly 190 into and down thelength of the cannula 20, protruding through the slot 21. When theselector switch 61 of the revolver 60 is mover to the “SCRAPER” setting,the revolver 60 rotates the slide lock 70 such that the notch 73 holdingthe scraper 90 is moved to the top of the tube assembly 71 and the notchin the bottom surface of the scraper 90 is positively engaged with thetool selector 78. Advancement of the tube assembly 71 would cause theadvancement of the scraper 90 into and down the length of the cannula20, protruding through the slot 21. In some embodiments, the toolselector 78 is welded, preferably laser welded, onto the top of the tubeelement of the tube assembly 71. In a preferred embodiment, the toolselector 78 is welded all around at its base to the tube element. Inparticular embodiments, the strength of the weld should be able towithstand the application of 5 in-lbs torque to the unit, moreparticularly 10 in-lbs torque. The tube assembly 71 further comprises atube stop 84 at the proximate end of the tube element. The tube stop 84retains the tube assembly 71 in the housing 30 of the device, preventingthe tube assembly from passing completely through the stabilizer disc 74(FIG. 10) at the proximate end of the housing 30. In some embodiments,the tube stop 84 is welded flush with the proximate end of the tubeelement of the tube assembly. In particular embodiments, the weld shouldbe strong enough to withstand at least 10 lbs normal force to the face,more particularly 20 lbs normal to the face. In some embodiments, theproximate portion of the tube assembly.

The tube assembly 71 can optionally be marked on the top or side surfacewith gradations 86,87 as exemplified in FIG. 17A to show the distancethat the tube assembly 71 has been advanced into the cannula 20. As anon-limiting example, major gradations 86 can be made to show eachcentimeter in distance that the tube assembly 71 has been advanced intothe cannula 20, with minor gradations 87 between them to show, forexample, each 1, 2, 2.5 or 5 millimeters. While the gradations can beapplied to the tube assembly 71 by any means known in the art, it ispreferable to lasermark the gradations on the tube assembly 71 foraccuracy and permanence. In some embodiments, the distance between themajor or minor gradations 86,87 corresponds to the distance between thetick marks 27 (FIG. 11A) in the sides of the slot 21 in the cannula 20.

FIG. 17 B shows a cross-section of the tube assembly 71 at the linebisecting FIG. 17A at A-A and looking in the direction of the tube stop84 at the proximate end. The tube assembly 71 has a central lumen 85that accommodates the insertion and free passage of an endoscope orother viewing device or tool, for example. FIG. 17C is a side view ofthe tube assembly 71 and FIG. 17 D is a perspective view of the tubeassembly 71 from an angle.

FIGS. 18A-C show an embodiment of the blade assembly 190, comprising apusher base 191 and a cutting blade 200. FIG. 18A is a side perspectiveview of the blade assembly 190. The pusher base 191 comprises a notch192 that positively engages with the tool selector 78 of the tubeassembly (FIGS. 17A, C and D). When the selector switch 61 of therevolver 60 (FIG. 10) is rotated to the “BLADE” position, the bladeassembly 190 is rotated upward by the slide lock 70 so that the notch192 in the base of the blade assembly 190 slides onto and engages thetool selector 78. The tool selector 78 then firmly holds the bladeassembly 190 on the surface of the tube assembly 71. Advancing the tubeassembly 71 also advances the blade assembly 190 into the cannula 20(FIG. 10). The blade assembly 190 protrudes through the longitudinalslot 21 in the cannula 20 and advancement of the blade assembly 190 withthe tube assembly 71 moves the blade 200 into contact with the targettissue. Further advancement of the blade assembly allows the blade 200to separate the target tissue. In preferable embodiments, the bottomsurface 210 of the blade 200 is at least slightly above the bottomsurface 193 of the pusher base 191 so that the blade 200 does notdirectly contact the body of the tube assembly 71, which may affectrotation of the blade assembly 190 into place for deployment. Inparticular embodiments, the end of the pusher base opposite the blade200 is angled so that it does not catch tissues as it is being withdrawnthrough the slot 21 of the cannula 20. FIG. 18B is an end view of theblade assembly 190. The width of the pusher base 191 is such that itsecurely contacts the side walls of the slot 21 in the cannula 20 (FIG.10) but is still able to be advanced or withdrawn through the slotwithout an amount of friction that would impede its progress. The sidesof the blade 200 do not contact the walls of the slot 21. In particularembodiments, the bottom surface 194 of the pusher base is curved tomatch the curvature of the tube assembly, thus inhibiting or preventingside to side motion, or wobble, of the blade assembly 190 duringdeployment. FIG. 18C is an angled perspective view of the blade assembly190. The view is clear so that the attachment of the blade 200 to thepusher base 191 can be seen. In particular embodiments, the blade 200comprises a tab 215 that embeds into the pusher base 191. In particularembodiments there is a hole 220 in the tab 215 that allows the materialof the pusher base 191 to flow through it when the pusher base 191 iscast, thereby securing the tab 215 into the pusher base 191. In someembodiments, the tab 215 is secured into the pusher base 191 using a pinor screw. In such an embodiment, the blade 200 may be replaceable in theblade assembly, allowing the use of blades with different profilesparticularly suited for a specific surgical procedure. For example, itmay be desirable to use a hook blade in some situations, where thecutting surface faces back towards the housing 30 of the device,allowing the practitioner to move the blade past the target tissue andseparate the target tissue by pulling the blade backwards, rather thanseparating the target tissue upon advancing the blade. The pusher base191 of the blade assembly 190 can be formed of any medically acceptablematerial, such as a plastic, as it does come in contact with bodytissues. In a particular embodiment, the pusher base 191 is formed ofpolycarbonate. In some embodiments, the blade assembly 190 may bereplaced in the device with any other suitable blade tool that engageswith the tool selector, such as, but not limited to, the blade 80 shownin FIG. 4 or a hooked endoscopic blade tool.

FIGS. 19A-E show a particular embodiment of the blade 200. FIG. 19Ashows a side view of the blade 200 embodiment. In a particularembodiment, the blade 200 as shown in FIG. 19A comprises an uppercutting surface 1 on the leading end of the blade, which is at an angle2 with respect to the horizontal orientation of the blade 200, asdefined by the bottom surface 210 of the blade 200. The angle 2 is suchthat the top of cutting surface 1 is forward of the bottom of thecutting surface. In one embodiment the angle 2 is between about 30 andabout 45 degrees. In a particular embodiment, the angle 2 is betweenabout 30 and about 40 degrees. In another particular embodiment, theangle 2 is between about 33 and about 39 degrees. In a more particularembodiment, the angle 2 is about 36 degrees.

In some embodiments, the upper end 3 of the cutting surface 1 isradiused. The radiused upper end 3 of the cutting surface 1 is about 90degrees of a circle and has a radius measurement between about 0.50 mmand 1.50 mm. In a particular embodiment, the radius is about 0.94 mm.

In a particular embodiment, the blade 200 as shown in FIG. 19A comprisesa lower cutting surface 4 on the leading end of the blade, which is atan angle 5 with respect to the horizontal orientation of the blade 200,as defined by the bottom surface 210 of the blade 200. The angle 5 issuch that the bottom of the lower cutting surface 4 is forward of thetop of the lower cutting surface. In one embodiment the angle 5 isbetween about 45 and about 65 degrees. In a particular embodiment, theangle 5 is between about 50 and about 60 degrees. In a more particularembodiment, the angle 5 is about 54 degrees. In some embodiments, thebottom of the lower cutting surface 4 is not radiused, as the bottom ofthe lower cutting surface 4 remains within the slot 21 of the cannula 20(FIG. 10) during deployment.

In a particular embodiment, the blade 200 as shown in FIG. 19A comprisesupper cutting surface 1 and lower cutting surface 4 on the leading endof the blade 200, which are at an angle 6 to one another and meet at acentral crotch 7. In one embodiment the angle 6 is between about 80 andabout 100 degrees. In a further embodiment, the angle 6 is between about85 and about 95 degrees. In a still further embodiment, the angle 6 isabout 90 degrees.

Still referring to FIG. 19A, in some embodiments, the plane where theupper and lower cutting surfaces meet is angled downward 8 towards thecrotch 7. In some embodiments, the angle 8, as it relates to the planedefined by the bottom surface 210 of the blade, is between about 0 and20 degrees. In further embodiments, the angle 8, as it relates to theplane defined by the bottom surface 210 of the blade, is between about 5and 15 degrees. In a particular embodiment, the angle 8, as it relatesto the plane defined by the bottom surface 210 of the blade, is about 9degrees. In particular embodiments, the crotch 7 is ground to have amaximum radius of between about 0.18 mm and about 0.58 mm, moreparticularly between about 0.28 mm and about 0.48 mm. In a still moreparticular embodiment, the crotch 7 is ground to have a maximum radiusof about 0.381 mm.

In some embodiments, in order to prevent the blade 200 from catching ontissues when the blade 200 is drawn backwards through the cannula 20,the top surface 211 of the blade 200 is angled downward and may comprisea further stepped angle 212, before fully descending 213 to meet the topedge 214 of the tab 215 that secures the blade 200 into the pusher base191. In a particular embodiment, the vertical height of the radius 3 atthe top end of the upper cutting surface 1 above the top edge 214 of thetab 215 is between about 0.75 mm and about 1.75 mm, more particularlybetween about 1.0 mm and about 1.50 mm. In a more particular embodiment,the vertical height 229 of the radius 3 at the top end of the uppercutting surface 1 above the top edge 214 of the tab 215 is about 1.26mm.

Additionally, in some embodiments, the trailing end 216 of the bottomsurface 210 of the blade 200 may be angled up to the bottom edge 217 ofthe tab 215. In a particular embodiment, the vertical height between thebottom surface 210 of the blade 200 and the bottom edge 217 of the tab215 is between about 0.1 mm and about 1.0 mm, more particularly betweenabout 0.3 mm and about 0.7 mm. In a more particular embodiment, thevertical height between the bottom surface 210 of the blade 200 and thebottom edge 217 of the tab 215 is about 0.5 mm.

Still referring to FIG. 19A, in some embodiments, the tab 215 is betweenabout 1.5 mm and about 2.0 mm high between the top edge 214 and bottomedge 217 of the tab 215, more particularly between about 1.65 mm andabout 1.85 mm. In a still more particular embodiment, the tab 215 isabout 1.75 mm high between the top edge 214 and bottom edge 217 of thetab 215. Additionally, in some embodiments, the tab 215 is between about20 mm and about 3.0 mm long between where it meets the top surface 211of the blade 200 (at 213) and the trailing edge 218 of the tab 215, moreparticularly between about 2.25 mm and about 2.75 mm. In a still moreparticular embodiment, the tab 215 is about 2.5 mm long between where itmeets the top surface 211 of the blade 200 (at 213) and the trailingedge 218 of the tab 215. The hole 220 in the tab 215 that serves tosecure the blade 200 into the pusher base 191 (FIG. 18C) is generallycentered horizontally and vertically in the tab 215 in order to providemaximum adhesion of the tab 215 to, and stability within, the pusherbase 191. The diameter of the hole 220 is between about 0.5 mm and about1.5 mm, more particularly between about 0.75 mm and about 1.25 mm. In amore particular embodiment, the diameter of the hole 220 is about 1.0mm.

In some embodiments, the crotch 7 of the blade 200 is between about 3.0mm and about 7.5 mm forward of the trailing edge 218 of the tab 215,more particularly between about 4.0 mm and about 6.5 mm. In a still moreparticular embodiment, the crotch 7 of the blade 200 is about 5.25 mmforward of the trailing edge 218 of the tab 215.

In particular embodiments, the blade 200 is made from stainless steel.In a further embodiment, the stainless steel is martensitic stainlesssteel. An exemplary martensitic stainless steel is Bohler-Uddeholm AEB-Lmartensitic stainless steel. In a still further embodiment, themartensitic stainless steel is heat-treated. In another furtherembodiment, the stainless steel is 440 A stainless steel. In aparticular embodiment, the blade is made from Hitachi GIN-5 SST-MODIFIED440-A stainless steel. The blade is optionally flash electropolished orpassivated per ASTM A967, or by any other method that delivers a similarfinish. The cutting edges are machine finished and must be sharp. In aparticular embodiment, the steel of the blade is heat-treated toRockwell C hardness of about 50-72. In a more particular embodiment, thesteel of the blade is heat-treated to R30N 75.7-77.5 (Rockwell Chardness of 58-60).

Referring now to FIG. 19B, the lower cutting surface 4 is a singlebeveled cutting surface and the angle 9 is between about 30 degrees andabout 50 degrees. In some embodiments, the angle 9 is between about 35degrees and about 45 degrees. In a particular embodiment, the angle 9 isabout 40 degrees. While not shown in the figure, the upper cuttingsurface 1 is a similarly a single beveled cutting surface and the angleis between about 30 degrees and about 50 degrees. In some embodiments,the angle is between about 35 degrees and about 45 degrees. In aparticular embodiment, the angle is about 40 degrees.

Also referring to FIG. 19B, in some embodiments, the depth of the grind225 of lower cutting surface 4, as well as for upper cutting surface 1,is between about 0.6 mm and about 1.1 mm. In other embodiment, the depthof the grind 225 is between about 0.7 mm and about 1.0 mm. In a furtherembodiment, the depth of the grind 225 is about 0.86 mm.

Referring now to FIG. 19C, in a particular embodiment, the overallheight 226 of the body of the blade 200 is between about 3.0 mm andabout 4.0 mm. In another embodiment, the height 226 of the body of theblade 200 is between about 3.25 mm and about 3.75 mm. In a moreparticular embodiment, the height 226 of the body of the blade 200 isabout 3.5 mm. Again referring to FIG. 1C, in a particular embodiment,the width 227 of the body of the blade 200 is between about 0.3 mm andabout 0.9 mm. In another embodiment, the width 227 of the body of theblade 200 is between about 0.45 mm and about 0.75 mm. In a particularembodiment, the width 227 the body of the blade 200 is about0.635+/−0.025 mm.

Referring to FIG. 19D, the total length 228 of the blade 200 from theleading point of the upper cutting surface 1 to the trailing end 218 ofthe tab 215 is between about 4 mm and about 10 mm. In another particularembodiment, the total length 228 of the blade 200 from the leading pointof the upper cutting surface 1 to the trailing end 218 of the tab 215 isbetween about 5.5 mm and about 8.5 mm. In a more particular embodimentthe total length 228 of the blade 200 is about 7.153 mm. FIG. 19Epresents an angled perspective view of an embodiment of the blade 200.

FIGS. 20 and 21 show perspective views of the blade assembly 190deployed into the cannula 20 of the device. Tube assembly 71 can be seenwithin the lumen of the cannula 20 with an endoscope extended throughthe tube assembly 71. The tool selector 78 is positively engaged withthe pusher base 191 of the blade assembly 190. The pusher base 191 andblade 200 are seen partially protruding from the slot 21 in the cannula20, but are securely held in the slot 21 by the tool selector 78 of thetube assembly 71.

FIG. 22 is another perspective view showing the assembled compactendoscopic surgical device of FIG. 9 with the blade assembly 190deployed.

FIGS. 23A-E show an embodiment of the scraper 90 of the compactendoscopic surgical device. As seen in FIG. 23A, the base 91 of thescraper 90 comprises a notch 92 that positively engages with the toolselector 78 of the tube assembly (FIGS. 17A, C and D). When the selectorswitch 61 of the revolver 60 (FIG. 10) is rotated to the “SCRAPER”position, the scraper 90 is rotated upward by the slide lock 70 so thatthe notch 92 in the base 91 of the scraper 90 slides onto and engagesthe tool selector 78. The tool selector 78 then firmly holds the scraper90 on the surface of the tube assembly 71. Advancing the tube assembly71 also advances the scraper 90 into the cannula 20 (FIG. 10). The teeth93 of the scraper 90 protrude through the longitudinal slot 21 in thecannula 20 and advancement of the scraper 90 with the tube assembly 71moves the teeth 93 into contact with the target tissue. Furtheradvancement of the blade assembly allows the teeth 93 to rake across thetarget tissue. In particular embodiments, the distal end 94 andproximate end 95 of the base 91 are rounded and angled downwards so thatthey do not catch tissues as the scraper 90 is being advanced orwithdrawn through the slot 21 of the cannula 20.

FIG. 23B is an end view of the scraper tool 90. The width of the base 91is such that it securely contacts the side walls of the slot 21 in thecannula 20 (FIG. 10) but is still able to be advanced or withdrawnthrough the slot without an amount of friction that would impede itsprogress. In particular embodiments, the bottom surface of the base 91is curved to match the curvature of the tube assembly, thus inhibitingor preventing side to side motion, or wobble, of the scraper 90 duringdeployment.

FIG. 23C is a perspective view of the top of the scraper 90 showing thelinear arrangement of the teeth 90. FIG. 23D is a cross-sectional viewof the scraper 90 at the line A-A through FIG. 23C. In some embodiments,the teeth are angled 96 to each other at between about 45 degrees and 75degrees, more particularly between about 55 degrees and about 65degrees. In a still more particular embodiment, the teeth 93 are angled96 to each other at about 60 degrees. In some embodiments the teeth 93are between about 1.0 mm and about 6.0 mm in height, more particularlybetween about 2.0 mm and about 4.0 mm. In a still more particularembodiment, the teeth 93 are about 3.23 mm in height. FIG. 23E is aperspective view of the scraper 90 from an angle. The scraper 90 can beformed of any medically acceptable material, such as a plastic,stainless steel, or nitinol, as it does come in contact with bodytissues. In a particular embodiment, scraper 90 is formed ofpolycarbonate.

FIG. 24 shows a perspective views of the scraper 90 deployed into thecannula 20 of the device. Tube assembly 71 can be seen within the lumenof the cannula 20 with an endoscope extended through the tube assembly71. The tool selector 78 is positively engaged with the scraper 90. Thebase 91 of the scraper 90 is seen partially protruding from the slot 21in the cannula 20, but is securely held in the slot 21 by the toolselector 78 of the tube assembly 71. The teeth 93 are fully exposed tothe environment outside the cannula 20 when deployed.

FIG. 25 is a side perspective view showing the assembled compactendoscopic surgical device of FIG. 9 with the scraper 90 deployed.

FIG. 26 is a top perspective view showing the assembled compactendoscopic surgical device of FIG. 9 with the scraper 90 deployed.

Kit

Another aspect of the present application relates to an instrument kitfor implementing an endoscopic surgical procedure. The instrument kitcontains an endoscopic surgical device comprising a slotted clearcannula, a blade and a housing, wherein the cannula is attached to thehousing, and further wherein the blade is enclosed in the housing and isslidable into the cannula.

In some embodiments, the endoscopic surgical device comprises a slottedclear cannula, a scraper, a blade and a housing, wherein, the cannula isattached to the housing, in a pre-deployment configuration the scraperand the blade are enclosed in the housing, the blade and scraper areindividually selectable for deployment orientation, and in deploymentorientation the blade or scraper are slidable into the cannula.

In some embodiments, the instrument kit comprises components andimplements useful for endoscopic procedures.

In one embodiment, the instrument kit further includes an endoscopesized for insertion into the slotted clear cannula for directvisualization of an operative site.

In another embodiment, the instrument kit further includes a scalpel.

In another embodiment, the instrument kit further includes an elevator.

In another embodiment, the instrument kit further includes a depth gaugemountable to a leading end of the endoscope.

In another embodiment, the instrument kit further includes a stop devicemountable on or in the cannula to prevent excessive penetration at asurgical site by the cutting instrument.

In another embodiment, the instrument kit further includes a curveddissector.

Method for Endoscopic Surgery

Another aspect of the present application relates to a method foruniportal endoscopic surgery. Uniportal endoscopic surgery allows thepractitioner to visualize a target tissue and its surrounding tissues aswell as perform a surgical procedure through a single entry portal. Insome instances, the entry portal may be a natural opening, while inother instances the entry portal is an incision. In the case of anincision, generally only a single small incision must be made. Inparticular embodiments, the incision is less than or equal to about 2 cmin length. In more particular embodiments, the incision is less than orequal to about 1.5 cm in length. In still more particular embodiments,the incision is less than or equal to about 1 cm in length. The singlesmall incision allows the patient to recover more quickly and begintherapy and/or resume normal activity as tolerated sooner.

The uniportal endoscopic surgical procedure described herein can be usedto implement a number of different surgical procedures including, butnot limited to, carpal tunnel release, Guyon's tunnel (or canal)release, cubital tunnel release, plantar fascia release, lateral releasefor patella realignment, release of radial tunnel, release of pronatarteres, release of trigger finger, release of lacertus fibrosus, releaseof the extensor tendons for lateral epicondylitis, release of medialepicondylitis, release of the posterior and other compartments of theleg, forearm fascia release for fascial compartment syndrome, release offascial compartments in the upper or lower extremities, relieving thecompression of a nerve by a ligament pulley or tunnel, and releasing thetravel of a ligament through a ligament pulley or tunnel.

One embodiment of the present application relates to a method for aperforming a uniportal endoscopic surgical procedure a target tissue ina subject. Generally, following the establishment of an entry portal, insome embodiments a blunt instrument, such as an elevator is insertedthrough the portal to establish an opening in the underlying tissuebetween the portal and the target tissue.

In one embodiment, an endoscopic surgical device comprising a slottedclear cannula, a blade and a housing, wherein the cannula is attached tothe housing, and further wherein the blade is enclosed in the housingand is slidable into the cannula, is inserted into the entry portal andextended through to the target tissue.

In some embodiments, the endoscopic surgical device comprises a slottedclear cannula, a scraper, a blade and a housing, wherein, the cannula isattached to the housing, in a pre-deployment configuration the scraperand the blade are enclosed in the housing, the blade and scraper areindividually selectable for deployment orientation, and in deploymentorientation the blade or scraper are slidable into the cannula.

An endoscope is inserted through the housing and into the cannula toview the target tissue and the surrounding tissues, assuring that theslot of the cannula is in proper orientation to the target tissue.

The paddle of the endoscopic surgical device is released from its lockedor parked position and advanced along the slot in the housing so thatthe knife is advanced further through the cannula so that the blademoves in contact with the target tissue through the slot, operativelyengaging the target tissue with the blade. The blade is further advancedthrough the cannula to divide the target tissue.

In one particular embodiment, the operative procedure is trigger fingerrelease.

In another particular embodiment, the establishing an entry portalcomprises making an incision.

In another particular embodiment, the target tissue is the A1 pulley.

The present invention is further illustrated by the following exampleswhich should not be construed as limiting. The contents of allreferences, patents and published patent applications cited throughoutthis application, as well as the Figures and Tables, are incorporatedherein by reference.

EXAMPLE 1 Uniportal Endoscopic Trigger Release

In a patient presenting with trigger finger of the middle or ringfinger, a 1 cm incision is made just proximal to the A1 pulley on thedistal palmar crease proximate to the affected digit.

An elevator is introduced into the incision and used to create a planesuperficial to the flexor tendon sheath. The elevator is withdrawn.

The cannula portion of an endoscopic surgical device comprising aslotted clear cannula, a scraper, a blade and a housing, wherein thecannula is attached to the housing, and further wherein the scraper andblade are enclosed in the housing, are individually selectable fordeployment and are slidable into the cannula is introduced into theincision and advanced through the plane created by the elevator. Theslot of the cannula is oriented facing the flexor tendon sheath.

The revolver of the device is set to allow the advancement of theendoscope without the deployment of the blade or scraper. The endoscopeis introduced through the guidance tube in the housing of the endoscopicsurgical device and into the cannula and advanced to visualize the A1pulley and A2 pulley.

In the event that the tenosynovium obscures visualization of the tendon,the revolver of the device is turned to select deployment orientation ofthe scraper. The guiding tube is advanced along the endoscope into thecannula and the scraper protrudes through the slot of the cannula. Thetenosynovium is removed with the scraper and the guiding tube isretracted, bringing the scraper back into the housing of the device. Therevolver of the device is rotated to restore the scraper back to itspre-deployment configuration in the device.

The tendon is again visualized with the endoscope. The revolver of thedevice is turned to select deployment orientation of the blade. Theguiding tube is advanced along the endoscope into the cannula and theblade protrudes through the slot of the cannula. The blade is advancedinto contact with the A1 pulley. The blade is further pushed forward,dividing the A1 pulley. The guiding tube is retracted, bringing theblade back into the housing of the device. The revolver of the device isrotated to restore the blade back to its pre-deployment configuration inthe device.

The cut edges of the A1 pulley and the underlying flexor tendon arevisualized through the endoscope.

While visualizing the tendon, release of the tendon is confirmed bypassive manipulation of the digit through its range of motion.

The absence of triggering is confirmed by having the subject flex andextend the affected digit.

The endoscope is withdrawn and the cannula is removed from the incision.

The wound is closed and a soft bandage is applied.

The patient is encouraged to begin early finger motion following surgeryand to resume daily activities as tolerated.

The above description is for the purpose of teaching the person ofordinary skill in the art how to practice the present invention, and itis not intended to detail all those obvious modifications and variationsof it which will become apparent to the skilled worker upon reading thedescription. It is intended, however, that all such obviousmodifications and variations be included within the scope of the presentinvention, which is defined by the following claims. The claims areintended to cover the components and steps in any sequence which iseffective to meet the objectives there intended, unless the contextspecifically indicates the contrary.

What is claimed is:
 1. A method for a performing a uniportal endoscopicsurgical procedure in a subject comprising: (a) establishing an entryportal in said subject; (b) inserting into said entry portal a slottedclear cannula from an endoscopic surgical device comprising: (i) ahousing having a proximate end and a distal end; (ii) a slotted clearcannula comprising a cannula body having a proximate end, a distal end,and a slot extending from said proximate end of said cannula body to theproximity of said distal end of said cannula body, wherein saidproximate end of said cannula body is attached to said distal end ofsaid housing; (iii) a revolver assembly within said housing, comprisinga slide lock having a proximate end, a distal end and two notches atsaid distal end; a scraper; a blade assembly; and a circular revolverbody comprising a selector switch, wherein said scraper and said bladereside at said two notches of said slide lock in a pre-deploymentposition and wherein said selector switch allows selection of saidscraper or said blade for deployment; (iv) a stabilizing ring withinsaid proximate end of said housing; and (v) a tube assembly having aproximate end and a distal end, wherein said distal end of said tubeassembly is located within said housing and extends through saidrevolver, and wherein said tube assembly is capable of entering saidslotted clear cannula from said proximate end of said clear cannula; (c)extending said cannula through said entry portal to said target tissue;(d) advancing an endoscope into said cannula visualize a target tissue;and (e) advancing said blade into said cannula until a desired cut ismade on said target tissue.
 2. The method of claim 1, wherein saidestablishing an entry portal comprises making an incision.
 3. The methodof claim 1, wherein said desired cut is division of said target tissue.4. The method of claim 1, further comprising: advancing said scraperinto said cannula to remove tenosynovium.
 5. The method of claim 1,wherein the uniportal endoscopic surgical procedure is selected from thegroup consisting of trigger finger release, carpal tunnel release,cubital tunnel release, plantar fascia release, lateral release forpatella realignment, release of the extensor tendons, release of theposterior or other compartments of the leg, and forearm fascial release.6. The method of claim 1, wherein the target tissue is selected from thegroup consisting of the A1 pulley, carpal tunnel, cubital tunnel andGuyon's tunnel.
 7. The method of claim 1, wherein said distal end ofsaid cannula body is closed.
 8. The method of claim 1, wherein saiddistal end of said cannula body is tapered.
 9. The method of claim 1,wherein the endoscopic surgical device further comprises a rotary clipthat prevents said scraper and said blade from sliding when inundeployed positions.
 10. The method of claim 9, wherein said rotaryclip comprises a tab that engages with an inside surface of said housingand an opening that allows deployment of said scraper or said blade. 11.The method of claim 1, wherein said circular revolver body comprises ahooked tab that engages with said slide lock.
 12. The method of claim 1,wherein said slide lock comprises a tab located between said two notchesat said distal end.
 13. The method of claim 12, wherein said slide lockfurther comprises one or more retaining tabs that hold a rotary clip.14. The method of claim 1, wherein said slide lock comprises a pair ofwings that engage with said circular revolver body.
 15. The method ofclaim 14, wherein said slide lock further comprises a disc at saidproximate end of said slide lock.
 16. The method of claim 1, whereinsaid tube assembly comprises a tool selector at said distal end of saidtube assembly.
 17. The method of claim 1, wherein said blade assemblycomprises a pusher base and a cutting blade, wherein said pusher basecomprises a notch that is capable of engaging with a tool selector onsaid tube assembly and wherein said cutting blade comprises a tab thatembeds into said pusher base.
 18. The method of claim 1, wherein saidcutting blade comprises an upper cutting surface that forms an upperangle with a bottom surface of said cutting blade.
 19. The method ofclaim 1, wherein said cutting blade further comprises a lower cuttingsurface that forms a lower angle with a bottom surface of said cuttingblade.